Telephone‐based CBT and the therapeutic relationship: The views and experiences of IAPT practitioners in a low‐intensity service
Abstract
Accessible summary: What is known on the subject: There is a move towards the use of new ways of delivering mental health care, particularly via an increased use of telephone therapies. Although some studies have noted the advantages of telephone‐delivered therapies (e.g., removing access barriers) and reported on equivalent therapeutic effects when compared to face‐to‐face, there are concerns about how telephone‐based therapy adversely affects the therapeutic relationship. What the paper adds to existing knowledge: It contributes new knowledge regarding psychological practitioners’ experience and views about using telephone‐based therapies and how this affects the therapeutic relationship. What are the implications for practice: This paper provides data about the new practitioner workforce (IAPT Psychological Wellbeing Practitioners) and adds to a growing area of research regarding their clinical role. It has relevance for mental health nursing, because health services internationally and across the professions are exploring how telehealth can improve health care. This paper suggests that mental health services need to focus on what type of therapeutic relationship their practice facilitates and on offering transparency to service users. It concludes that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to focus on what facilitates and inhibits deeper therapeutic closeness and connection. Introduction: Over‐the‐telephone (OTT)‐delivered psychological therapies as an alternative method to face‐to‐face (F2F) are becoming more prevalent in mental health care. Research suggests a range of benefits of OTT use in therapy, but there are growing concerns about its consequences for the therapeutic relationship. This paper presents new knowledge regarding psychological practitioners’ experience and views of OTT work and its potential effects on the therapeutic relationship in the context of the UK's Increasing Access to Psychological Therapy (IAPT) programme. Aim: This paper presents IAPT practitioners’ experiences and views of OTT work and its potential effects on the therapeutic relationship. Methods: Completed questionnaires (exploring OTT versus F2F work) which were distributed to IAPT practitioners revealed a concern about the therapeutic relationship in OTT. To explore this further, nine in‐depth semi‐structured interviews with PWP s were conducted and the findings from this qualitative study are reported here. Results: Practitioners noted OTT use facilitated access and flexibility for service users; however, they expressed some concern over the adverse effect of OTT on the therapeutic relationship. Discussion: Although a working alliance was possible OTT, this research suggests the type of therapeutic relationship formed OTT in a “low contact–high volume” service such as IAPT needs to be better defined. By addressing this, dissonance which might arise between practitioner aims and the aims of IAPT can be reduced. This research also contributes to wider debates regarding mental health care and its provision in the UK. Implications for practice: This paper concludes that mental health services need to focus on what type of therapeutic relationship their practice facilitates and to offer transparency to service users. The findings suggest that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to offer a more nuanced understanding of the concept of a therapeutic relationship and focus on what facilitates and inhibits deeper therapeutic closeness and connection.
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The use of the telephone for delivery of psychological interventions has enabled wider access to treatment for patients.
“The use of the telephone for the delivery of psychological interventions has undoubtedly enabled wider access to treatment for patients [10–12].”
From 'I didn't know what to expect': Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions (2020) · cites this paper as [10]
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- Authors
- Turner, J., Brown, J. C., & Carpenter, D. T.
- Affiliations
- University of Southampton (GB)
- Corresponding author
- Brown, J. C.
- Venue
- Journal of Psychiatric and Mental Health Nursing
- Publisher
- Wiley
- Published
- 2018-01-30
- Volume
- 25
- Issue
- 5-6
- Pages
- 285-296
- ISSN
- 1351-0126 (ISSN-L)
- 1365-2850
- OpenAlex
- W2768060396
- Cited by
- 37
- References
- 93
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 2 · 2023: 7 · 2022: 6 · 2021: 6 · 2020: 8 · 2019: 2
- FWCI
- 2.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric and Mental Health Nursing (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- telephone-delivered therapy, therapeutic relationship, telemedicine, practitioner experiences
- MeSH terms
- Adult, Attitude of Health Personnel, Humans, Professional-Patient Relations, Telephone, Cognitive Behavioral Therapy, Telemedicine
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